Coccidynia

Coccidynia is classically defined as pain in the coccyx region. It may occur secondary to a fracture in coccyx or a ligamentous sprain in sacrococcygeal ligament. Patients usually complaint of pain while sitting on hard surface, or during defecation.
Treatment is mainly supportive.
Most patients respond to Ultrasonic and IFT stimulation therapy. In resistant cases, local steroid injection along with local anaesthetic may be given.
Surgical option is considered, in rare circumstances.

Cervical Radiculopathy in Pregnancy

Patients suffering from neck pain and radiating along one of the shoulder or the whole upper limb is a common scenario. But things get more complicated when it happens in the backdrop of Pregnancy or in lactating mothers.
Now, the limitations starts as most of the drugs we traditionally use to counter a cervical radiculopathy have a risk of crossing the placenta or getting excreted in the breast milk. Most of such drugs have been known to produce teratogenic effects in the fetus; or the least their safety has not been proven till date.
I had a consultation with the physiotherapist at our set up.
I believe the only remedy we can offer is a mix of Electrotherapy and support to the neck region with avoidance of all precipitating events.

Interferential therapy has shown consistently good results in patients with neuritis or radicular pain. Although, the safety of IFT in Pregnancy has not been conclusively proven, it is supposed to be least harmful, when we need to balance between risks and benefits.
It may be combined with posture training, Neck Isometric exercises and Cervical Collar. All these contribute in symptomatic improvement.
Drugs like Gabapentin and Pregabalin should be avoided at all costs, due to inherent risk of teratogenecity, unless we have more studies to support its usage.

Cervical Spondylosis

Cervical Spondylosis, as we Orthopaedicians describe, is the degenerative change in the Cervical spine vertebrae often presenting on X-ray film as excess bone formation at the vertebral body margins, due to a chronic degenerative pathology. So, a young patient with acute onset neck pain, being diagnosed as Cervical Spondylosis is a Misnomer.

An X-ray film of the Neck is a good basic test to diagnose Cervical spondylosis. It often presents with Chronic, dull aching pain which aggravates with extremes of movement. Using a collar provides more psychological reassurance, than actually treating the pathology. A soft/ hard collar is more effective in treating acute muscle spasms of the neck usually precipitated by some injury or an acute disc prolapse. In such cases, we suggest restriction of neck movements to prevent further injury.

Two more synonymous terms that need a mention are- Spondylitis, and Spondylolisthesis. The former is an inflammation of the spinous processes of the vertebra, while the latter suggests abnormal translation of one vertebra over another leading to a loss of sagittal balance.

The preferred treatment for a Cervical Spondylosis is supervised physiotherapy. Gentle stretching exercises along with Isometric exercises of the neck help in improving the muscle tone of para-vertebral muscles. Heat therapy in the form of Interferential therapy (IFT) and Ultrasonic therapy also help relieve the symptoms.

Patients with long- standing symptoms often develop multiple level disc bulges with dessication (dryness of disc), as evident on the MRI. If severe, it may produce compression on the exiting nerve root and produce tingling and numbness in the upper limbs.

Surgical treatment is suitable to those with single or two level disc bulges, wherein a fusion of the vertebrae may be performed with or without instrumentation.

Cervical disc replacement is a novel treatment offered to those with single level disc prolapse, and without excessive facet joint arthritis. It offers reasonable movement at the vertebral interface, and is better tolerated by the younger active population.